Clinical Trial Helps Veteran Beat Lung Cancer Odds

May 25, 2010 – After surviving Vietnam, lung cancer is just another battle for Dallas Carr.

With his Jamaican accent, dreadlocks and laid-back personality, Carr said people are often surprised to learn he is a U.S. Army veteran. Carr went to war at age 17, fresh out of high school. He retired 20 years later as a sergeant first class.

"So I already beat those odds," said Carr, 57. "If a person saw me now, they would never know I'm dying. I don't have that attitude. It's a battle I have to fight."

Now the battlefield is his body. Carr was diagnosed with advanced lung cancer in 2004. At one point, doctors gave him six weeks to live, he said.

In 2005, Carr joined a clinical trial testing an experimental oral chemotherapy drug at the Siteman Cancer Center at Barnes-Jewish St. Peters Hospital. Carr was one of the new center's first patients.

"I thought, what do I have to lose?" Carr said. "I have terminal cancer here. If you are on death row, why not try to live?"

Five years later, Carr is one of the few surviving members of the original study group.

"Dallas is an unbelievable success story," said Dr. Timothy Pluard, the center's medical director. "The average life expectancy for stage IV lung cancer is about one year. But Dallas has been on this experimental drug for five years. He has relatively minimal side effects, and he's living a normal life."

Carr, of O'Fallon, Mo., has a son, daughter and three grandchildren, plus a fourth grandchild on the way.

"As long as they live, part of me lives," Carr said. "I really want to be there and be part of their lives so they know who I am. I thought I was being robbed of this. But through my faith and spirituality, I am still with them."

More than 300 people have participated in clinical trials at Siteman Cancer Center's St. Peters location since it opened five years ago. At any given time, 125 patients might be taking part in trials, Pluard said.

"Part of the reason is a stigma where patients feel they are being experimented upon," Pluard said. "Patients say they don't want to be a guinea pig. But every standard cancer treatment we have right now exists because it was proven in a clinical trial to be the best treatment."

Sharon Lee, the St. Peters center's manager, said doctors are trying to combat misconceptions and increase participation in clinical trials, especially among minorities.

Lee said some people think they will receive a placebo if they participate in a clinical study, but everyone in the study receives, at minimum, the standard care any other cancer patient would receive. Some patients receive additional care, such as drugs not yet approved by the Food and Drug Administration, or different dosages of approved drugs. Even the unapproved drugs go through "rigorous review" before used on humans, Lees said.

"It is a very defined process of oversight," Lee said. "The reporting and documentation is so detailed, it holds us to a higher standard of accountability than for people who receive only standard-of-care treatment."

Pluard said the minority community has an "historic distrust of the medical profession," leading to under-representation of African Americans in clinical trials.

Pluard and Lee said some of this distrust stemmed from the Tuskegee experiment, a 40- year study the U.S. government conducted among low-income African Americans in Tuskegee, Ala. Researchers examined the progression of untreated syphilis on the black test subjects, giving them misinformation about their condition and withholding existing penicillin treatments. Syphilis attacks the brain and nervous system and is ultimately fatal, Pluard said. The Tuskegee study concluded in 1972.

Some cancers, like prostate cancer and multiple myeloma, affect blacks disproportionately to whites. Clinical trials for drugs aimed at these cancers should have greater participation from African-Americans, Pluard said.

Dr. Lannis Hall, director of radiation oncology at the Siteman Cancer Center at Barnes-Jewish St. Peters Hospital, leads the Program for the Elimination of Cancer Disparities. The group studies the difference in clinical trial participation between racial and ethnic minorities. Hall is trying to increase participation so the studies mirror cancer incidence rates among those minorities.

"If a trial only has white people, her team can close it down," Lee said. "She can tell them to go back to the drawing board and redesign the trial so it has equal accessibility to all races and genders."

Being Jamaican, Carr said he might have a different cultural perspective than many African Americans.

"Most minorities, they have to be almost dead before they go to the doctor," Carr said. "It could be their upbringing. We have got to make minorities aware that they need to check this out."

Carr said he felt a responsibility to do something that would help other people fight cancer.

"I am my brother's keeper, and my brother should be my keeper," he said. "My whole reason for accepting the study drug was, if I can have an impact, or help someone else survive this thing, why not? We are here to take care of one another."